Medical Questions » Nerves Questions » Question No. 721
| Question: | I suffer severely from trigeminal neuralgia, which is not relieved by painkillers. What causes this dreadful pain? |
| Answer: | The trigeminal nerve leaves the brain and passes through a hole in the skull just beside the ear. From there it fans out across the face ro receive sensations from the skin of the face and ro give instructions to the muscles in the face.
Neuralgia is nerve pain, and patients with trigeminal neuralgia (also known as ' tic douloureux' ) experience sudden, severe pain in the trigeminal nerve. The pain often arises beside the mouth, and spreads almost instantly up to the eye, down to the jaw, and across to the ear. The pain may last a few seconds or several minutes. Only one side of the face is affected.
Attacks of pain may be started by cold winds, eating, yawning or touching the face. The pains tend to come in episodes, with attacks coming every few minutes for a few days or weeks, and then disappearing for a time. Unfortunately, each successive attack tends to last longer than the preceding one, and the pain-free periods become shortet.
Occasionally, trigeminal neuralgia may be caused by a brain or nerve disease such as multiple sclerosis, but usually there is no specific cause, and there are no tests available to prove the diagnosis.
A number of drugs can be used to control the condition. Pain-killers are not particularly effective, but antiepileptic drugs are quite successful.
If these medications prove unsuccessful, surgical exploration of the nerve may find an area of compression or abnormality as a cause of the pain. Very rarely, as a last resort, the nerve may be destroyed to give relief from intractable pain, but this leaves the face numb and paralysed.
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